Article

lock Open Access lock Peer-Reviewed

6

Views

ORIGINAL ARTICLE

Blalock-Taussig operation for palliative treatment of congenital heart disease with low pulmonary flow

Miguel A MalufI; José Carlos S AndradeI; Antônio CarvalhoI; Roberto CataniI; Hermínio VegaI; José L AndradeI; Célia SilvaI; Werther B CarvalhoI; Ênio BuffoloI

DOI: 10.1590/S0102-76381995000300002

ABSTRACT

From January 1990 to November 1994, 72 patients with congenital heart defects and low pulmonary flow underwent modified Blalock-Taussig produce. There were 44 (61.1%) males and 28 (38.8%) females with ages ranging from 2 days to 11 years (average 9 months). Thirty eight (52,8%) patients had Tetralogy of Fallot; 7 (9,7%) had pulmonary atresia with intact ventricular septum (PA/IVS); 6 (8.4%), had transposition of the great arteries (TGA) with pulmonary stenosis (PS); 6 (8,4%) had tricuspid atresia (TA) with PS; 6 (8.4%) had double inlet of right ventricle (RV) or left ventricle (LV) and PS; 3 (4.2%) had corrected transposition of the great arteries (CTGA) with ventricular septal defects (VSD) and PS; 2 (2.7%) had double outlet of RV or LV and PS; 2 (2.7%) had atrio-ventricular canal defects (A-VC) and PS; 2 (2.7%) patients had right or left Isomerism and PS. The decision to surgical indication was based on: a) new borns with "ductus dependent" heart defects; b) lactents with important cianosis or hypoxia; c) infants with heart defects without possibilities of biventricular correction. The surgical technique employed was the Blalock-Taussig operation using 4 or 5 mm Polytetrafluoroethy (PTFE) prosthesis in 69 (94.5%) cases, umbilical vein in 3 (4.1%) cases and bovine thoracic artery in 1 (1.4%) case. Before the arteries were clamped 1 mg/kg of héparine was given without mobilization, with protamine, after the procedure. During the post-operative period, anticoagulants were not given. The prosthesis obstruction was the main cause of death and was related to artery anatomy: subclavian and pulmonary artery diameter and/or problems with the technique. The modified Blalock-Taussig operation showed itself to be a reliable palliative treatment to heart defects with low pulmonary flow.

RESUMO

De janeiro de 1990 a novembro de 1994, 72 pacientes portadores de cardiopatias congênitas com hipofluxo pulmonar foram submetidos à operação de Blalock-Taussig. A idade variou entre 2 dias e 11 anos (M:9,0 meses); 44 (61,1%) eram do sexo masculino e 28 (38,8%) do feminino; 38 (52,8%) casos portadores de tétrade de Fallot; 7 (9,7%) atresia pulmonar com septo interventricular íntegro (AP c/ SIVI); 6 (8,4%) transposição das grandes artérias (TGA) + estenose pulmonar (EP); 6 (8,4%) atresia tricúspide (AT) + EP; 6 (8,4%) dupla via de entrada (DVE) do ventrículo direito (VD) ou ventrículo esquerdo (VE) + (EP); 3 (4,2%) transposição corrigida das grandes artérias (TCGA) + comunicação interventricular (CIV) + EP; 2 (2,7%) dupla via de saída (DVS) de VD ou VE + EP; 2 (2,7%) defeito septal atrioventricular (DSAV) + EP; 2 (2,7%) isomerismo direito (D) ou (E) + EP. Os critérios de indicação foram: a) neonatos com cardiopatias "dueto dependente"; b) lactentes com piora de cianose ou crise de hipoxia; c) crianças durante a infância com cardiopatias sem chance de uma correção biventricular. A técnica empregada foi a operação de Blalock-Taussig modificada, interpondo prótese entre artéria subclávia e artéria pulmonar. A prótese de Polytetrafluoroethylene (PTFE) foi usada em 69 (94,5%) casos, veia umbilical em 3 (4,1%) casos e artéria mamária bovina em 1 (1,4%) caso. Durante o ato operatório foi administrada dose única de heparina (1mg x kg peso), não sendo neutralizada no pós-operatório (PO) e no seguimento tardio, dispensado o uso de anticoagulantes ou antiagregantes plaquetários. Houve 8 (11,1%) óbitos no PO imediato: 5 (6,9%) casos por obstrução da prótese (3 foram reoperados), 2 (2,7%) casos por morte súbita (AP c/ SIVI) e 1 (1,3%) devido a processo infeccioso pulmonar. A obstrução da prótese como principal causa de óbito esteve diretamente relacionada à anatomia dos vasos (calibre da artéria subclávia e pulmonar) e ou problemas de técnica cirúrgica. A operação de Blalock-Taussig modificada demonstrou ser um método confiável e seguro no tratamento paliativo das cardiopatias com hipofluxo pulmonar.
Full text available only in portuguese PDF format.

REFERENCES

1. AMATTO, J. J.; MARBEY, M. L.; BUSH, C.; GALDIERI, R. J.; COTRONEO, J. V.; BUSHONG, J. - Systemic-pulmonary polytetrafluorethylene shunts in palliative operations for congenital disease: revival of the central shunt. J. Thorac. Cardiovasc. Surg., 95: 62-69, 1988. [MedLine]

2. ARCIENAGAS, E.; FARROKI, Z. Q.; HAKIMI, M.; PERRY, B. L.; GREEN, E. W. - Classic shunting operations for congenital cyanotic heart defects. J. Thorac. Cardiovasc. Surg., 84: 88-96, 1982. [MedLine]

3. BLALOCK, A. & TAUSSIG, H. - Surgical treatment of malformations of the heart in which there is pulmonary stenosis or pulmonary atresia. JAMA, 128: 189-202, 1945.

4. BOVE, E. L; KOHMAN, L; SEREIKA, S.; BYRUM, C. J.; KAVEY, R. E. W.; BLACKMAN, M. S.; SONDHEIMER, H. M.; ROSENTHAL, A. - The modified Blalock-Taussig shunt: analysis of adequacy and duration of palliation. Circulation, 76 (Supl 3): 19-23, 1987.

5. CIARAVELLA, J. M. & MIDGLEY, F. M. - Construction of interposition polytetrafluoroethylene ascending aorta-pulmonary artery shunt. Ann. Thorac. Surg., 26: 570-572, 1980.

6. De LEVAL, M. R.; McKAY, R.; JONES, M.; STARK, J.; MACARTNEY, F. J. - Modified Blalock-Taussig shunt: use of subclavian artery orifice as flow regulator in prosthetic systemic-pulmonary artery shunts. J. Thorac. Cardiovasc. Surg., 81: 112-129, 1981.

7. GAZZANIGA, A. B.; ELLIOT, M. P.; SPERLING, D. R. DIETRICK, W. R.; EISENMAN, J. I.; McRAE, D. M.; BARTLETT, R. H. - Microporous expanded polytetrafluoroethylene arterial prosthesis for construction of aortopulmonary shunts: experimental and clinical results. Ann. Thorac. Surg., 21: 322-327, 1976. [MedLine]

8. GUYTON, R. A.; OWENS, J. E.; WAUMETT, J. D.; DOOLEY, K. J.; HATCHER, C. R.; WILLIAMS, W. H. - The Blalock-Taussig shunt: low risk, effective palliation, and pulmonary artery growth. J. Thorac. Cardiovasc. Surg., 85: 917-922, 1983. [MedLine]

9. ILBAWI, M. N.; GRIECO, J.; DeLEON, S. Y.; IDRISS, F. S.; MUSTER, A. J.; BERRY, T. E.; KLICH, J. - Modified Blalock-Taussig shunt in newborn infants. J. Thorac. Cardiovasc. Surg., 88: 770-775, 1984. [MedLine]

10. LAMBERTI, J. J.; CARLISLE, J.; WALDMAN, J. D.; LODGE, F. A.; KIRKPATRICK, S. E.; GEORGE, L.; MATHEWSON, J. W.; TURNER, S. W.; PAPPELBAUM, S. J. - Systemic-pulmonary shunts in infants and children: early and late results. J. Thorac. Cardiovasc. Surg., 88: 76-81, 1984.

11. LEÃO, L. E. V.; ANDRADE, J. C. S.; SUCCI, J. E.; CUEVA, C. C; RIBEIRO, E. E.; CARVALHO, A. C. C; BUFFOLO, E. - Modified Blalock-Taussig shunt with an umbilical vein graft. Texas Heart Inst. J., 12: 65-71, 1985.

12. MALUF, M.; ANDRADE, J. C.; CATANI, R.; CARVALHO, A. C; LIMA, W. C; ANDRADE, J. L; LEÃO, L. E. V.; BUFFOLO, E. - Derivação sistêmico-pulmonar em cardiopatias congênitas com hipofluxo pulmonar: análise crítica da técnica cirúrgica e resultados imediatos. Arq. Bras. Cardiol., 56: 281-286, 1991. [MedLine]

13. STEWART, S.; ALEXON, C.; MANNING, J. - Long-term palliation with the classic Blalock-Taussig shunt. J. Thorac. Cardiovasc. Surg., 96: 117-121, 1988. [MedLine]

14. ULLOM, R. L.; CRAWFORD, F. A.; ROSS, B. A.; SPINALE, F. - The Blalock-Taussig shunt in infants: standard versus modified. Ann. Thorac. Surg., 44: 539-543, 1987. [MedLine]

15. VOUHÉ, P. R.; CALIANI, J.; TAMISIER, D. - Systemic-pulmonary shunts using a preserved bovine internal mammary artery. In: Proceedings of Bioflow Small Diameter Graft Symposium-Garmisch 1989. St. Paul, Biovascular Inc., 1989, p. 23-30.

CCBY All scientific articles published at rbccv.org.br are licensed under a Creative Commons license

Indexes

All rights reserved 2017 / © 2024 Brazilian Society of Cardiovascular Surgery DEVELOPMENT BY